Mind-body interactions in the regulation of airway inflammation in asthma: A PET study of acute and chronic stress

Abstract

Background Psychological stress has long been recognized as a contributing factor to asthma symptom expression and disease progression. Yet, the neural mechanisms that underlie this relationship have been largely unexplored in research addressing the pathophysiology and management of asthma. Studies that have examined the mechanisms of this relationship in the periphery suggest that it is the superimposition of acute stress on top of chronic stress that is of greatest concern for airway inflammation. Methods We compared asthmatic individuals with high and low levels of chronic life stress in their neural and peripheral physiological responses to the Trier Social Stress Test and a matched control task. We used FDG-PET to measure neural activity during performance of the two tasks. We used both circulating and airway-specific markers of asthma-related inflammation to assess the impact of acute stress in these two groups. Results Asthmatics under chronic stress had a larger HPA-axis response to an acute stressor, which failed to show the suppressive effects on inflammatory markers observed in those with low chronic stress. Moreover, our PET data suggest that greater activity in the anterior insula during acute stress may reflect regulation of the effect of stress on inflammation. In contrast, greater activity in the mid-insula and perigenual anterior cingulate seems to reflect greater reactivity and was associated with greater airway inflammation, a more robust alpha amylase response, and a greater stress-induced increase in proinflammatory cytokine mRNA expression in airway cells. Conclusions Acute stress is associated with increases in markers of airway inflammation in asthmatics under chronic stress. This relationship may be mediated by interactions between the insula and anterior cingulate cortex, that determine the salience of environmental cues, as well as descending regulatory influence of inflammatory pathways in the periphery.

Exhaled breath analysis in evaluation of psychological stress: A short literature review

“…More recently, Rosenkranz et al () assessed FeNO levels in two samples of patients with mild allergic asthma, with high ( n = 15) and low ( n = 15) degrees of chronic stress, according to the University of California, Los Angeles (UCLA) Life Stress Interview (Hammen, ). Such patients were evaluated at baseline and after a stressful situation, delivered through the TSST.…”

“…In fact, while Ritz et al (, ) found increased levels of FeNO after the presentation of an acute stressor, the same group (Ritz et al, ) found a decrease in FeNO with more sustained stress, which was also associated with depression. One possible explanation for such outcomes is the different behaviours of asthmatic individuals depending on their prior stress level, as found by Rosenkranz et al (), who reported high FeNO levels among participants within the low‐stress cohort and low levels for those at high stress already at baseline. In addition, the individuals with low stress experienced a decrease in FeNO following stress administration, whereas participants with higher stress saw their FeNO levels increase after the same stimulation.…”

“…Another possible explanation for those conflicting results is that acute stressors drive FeNO levels to rise, especially in less depressed individuals (Ritz et al, , ; Rosenkranz et al, ) – inversely to the cortisol response to the stressor – whereas prolonged periods of stress are associated with a decrease in FeNO, particularly among more depressed individuals (Ritz et al, ; Trueba, Smith, et al ).…”

Integrative Medicine for Respiratory Conditions

“…In addition, poor asthma control is highly associated with greater symptoms of anxiety and depression. 43 Individuals with high chronic stress exhibit a greater cortisol response to an acute stressor, as well as increases in blood and sputum eosinophils, whereas these relationships are opposite in those with low chronic stress. 43 Thus, a true psychoneuroimmunological association has been established between asthma and stress/anxiety.…”

“…43 Individuals with high chronic stress exhibit a greater cortisol response to an acute stressor, as well as increases in blood and sputum eosinophils, whereas these relationships are opposite in those with low chronic stress. 43 Thus, a true psychoneuroimmunological association has been established between asthma and stress/anxiety. While external stress can trigger or worsen chronic asthma, research has shown that intrinsic stress can have the same effect.…”